Healthcare Provider Details

I. General information

NPI: 1417945304
Provider Name (Legal Business Name): DONALD L SEIDLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 12/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4602 MACCORKLE AVE SE
CHARLESTON WV
25304-1848
US

IV. Provider business mailing address

415 MORRIS ST SUITE 304
CHARLESTON WV
25301-1842
US

V. Phone/Fax

Practice location:
  • Phone: 304-925-4777
  • Fax: 304-925-4870
Mailing address:
  • Phone: 304-388-7783
  • Fax: 304-388-7788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number21998
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21998
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: